Health Psychology in Nursing Practice
Publication Year: 2016
Health Psychology in Nursing Practice gives nurses and healthcare practitioners the essentials of health psychology to assist patients and their relatives in adjusting to diagnoses, coping with treatments and other disease–related life changes, managing symptoms and making healthy choices. Directly aimed at nurses, this textbook helps them improve their practice in a very practical way. Key features: * Concise content specifically aimed at nurses and other healthcare professions and taking both an evidence-based and applied approach * Key learning objectives and chapters summaries for revision * Case examples give even more insight into how theory works in the real world * Reflective activities help think about real life practice and quizzes test your knowledge Elizabeth Barley is a Chartered Psychologist and Practitioner Health Psychologist and ...
- Front Matter
- Back Matter
- Subject Index
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© Elizabeth Alexandra Barley 2016
First published 2016
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ISBN 978-1-4739-1367-7 (pbk)
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About the Author
Publisher’s Acknowledgements[Page ix]
The author and publisher would like to thank the following for their kind permission to republish material.
Figure 1.1: The Biomedical Model is adapted from a figure produced by Paul Leimkuehler and reproduced with kind permission of the American Academy of Orthotists and Prosthetists.
Figure 1.2: The Biophychosocial Model: a holistic model is an adaptation reproduced with kind permission of the American Academy of Orthotists and Prosthetists.
Table 2.1: Adapted by permission of the publisher from: Fishkind, A. (2002) Calming agitation with words, not drugs: 10 commandments for safety. Current Psychiatry. 1(4):32–34,37–39. Copyright © 2002 Frontline Medical Communications.
Table 2.2: Adapted from National Institute for Health and Care Excellence (2011) CG 123 Common mental health disorders: Identification and pathways to care. Manchester: NICE. Available from www.nice.org.uk/CG123. Reproduced with permission.
Figure 3.1: Reprinted from Clatworthy, J., Bowskill,R., Parham,R., Rank, T., Scott, J. and Horne, R. (2009) Understanding medication non-adherence in bipolar disorders using a Necessity-Concerns Framework. Journal of Affective Disorders. 116 (1–2): 51–5, with permission from Elsevier.
Table 3.1: Reprinted from Abdel-Tawab, R., James, D.H., Fichtinger, A., Clatworthy, J., Horne, R. and Davies, G. (2011) Development and validation of the Medication-Related Consultation Framework (MRCF). Patient Education and Counseling. 83(3): 451–7, Copyright 2011, with permission from Elsevier.
Figure 4.2: Published in Hall, P.A. and Fong G.T. (2007) Temporal self-regulation theory: A model for individual health behavior. Health Psychology Review. 1: 6–52. DOI: 10.1080/17437190701492437. Reprinted by permission of Taylor and Francis Ltd.
Box 7.1: The EAST Framework – four simple ways to apply behavioural insights reproduced with permission of The Behavioural Insights Team.
Our choice of a career in healthcare reflects our commitment to make the world a better place. We want to improve the lives of our patients and clients. As nurses, midwives, health visitors and allied health professionals our work is to support people to cope with illness, to prevent disease and, generally, to help people to be as well as they can be. This is true whatever the field or setting in which we work.
To ensure that we provide the best quality care, we have long since embraced the concept of evidence-based practice. Research evidence combined with our clinical expertise and our understanding of patient preferences ensures that the care and health advice we give is effective. However, even when people have an evidence-based treatment plan, they do not always follow it. Do all our patients take their prescribed medications as they should? Do they turn up for all their appointments or follow our diet, exercise or symptom management advice? In spite of a plethora of health education interventions, do we all eat healthily, drink only moderate amounts of alcohol, exercise enough, avoid tobacco and take up available preventative healthcare such as cancer screening? That, worldwide, the rates of preventable disability, morbidity and mortality are increasing provides the answer to these questions!
No single profession can address this alone. Health psychology is a discipline which has arisen to try to understand our health-related behaviour and to determine what support people need to be as well as they can be. In writing this book, I aim to illustrate how health psychology knowledge and techniques can complement the specialist skills and knowledge of nurses, midwives, health visitors and allied health professionals to help them to deliver the best possible care.Scope of this Book
This book is meant to introduce you to the discipline of health psychology. There are many health psychology textbooks available which cover a wide range of topics. As both a nurse and a health psychologist, I have given much consideration to which topics would be most useful to non-psychologist professionals. I decided to focus on those which have been identified through research and policy as challenges for nurses, midwives and health visitors and for anyone wanting to improve the health and wellbeing of patients and the public. There are therefore chapters on how health psychology relates to nursing, midwifery and health visiting practice in the context of: emotions and health (Chapter 2); improving self-management (Chapter 3); promoting healthy choices (Chapter 4); and managing enduring physical symptoms (Chapter 5). I also include a chapter on looking after yourself (Chapter 6), because we too deserve good health and wellbeing and without it, how can we care for others?
[Page xi]To set all of this in context, the book starts with a chapter explaining why nurses, midwives and health visitors need psychology (Chapter 1). This, and other chapters, introduce you to some health psychology models. I have tried to keep discussion of these as simple as possible as I understand that theory can seem dry. Nevertheless, I encourage you to consider the ideas within them in relation to your patients. It is my hope that knowledge of health psychology will encourage reflective practice and stimulate new ways of thinking.
Throughout, I present and critically appraise the research evidence for the health psychology theories and interventions discussed, and highlight where more evidence may be needed. You will find the reference list is long! This is designed to help you to decide whether or not you want to use the techniques you read about; the information in Chapter 7 will also help you to consider whether you are competent to apply health psychology knowledge and techniques to your practice. This evidence-based approach has meant that the focus of the book is predominantly on cognitive behavioural theories and techniques, simply because that is the approach which is currently dominant within health psychology and the most researched.
Above all, I have taken an applied approach to introducing you to health psychology. Where possible I have provided case examples to bring the ideas to life. In Chapter 7, I also highlight life-stage-related issues, which will be relevant to health psychology-informed practice. Much of the content focuses on behaviour change, which is a key topic in health psychology and very relevant to nurses and other health professionals who are supporting people to change their behaviour to manage or prevent illness. The focus is on individual behaviour change, though behaviour change at a population level is also considered since nurses have an increasing role in health promotion. In essence, this book is a straightforward, introductory text which provides an accessible and practical guide to using health psychology to enhance your practice.Who is this Book for?
This book is intended as a core textbook for pre- and post-registration nursing and midwifery students who are undertaking undergraduate degree, postgraduate diploma or other postgraduate nursing programmes. I have also tried to highlight the relevance to health visiting, so health visitors and those aspiring to be health visitors in future should also find this helpful. Nurse training and/or healthcare systems may be divided into distinct fields, such as adult, mental health, child, learning disability and midwifery; however, this book is not structured that way, rather general principles are illustrated with case examples designed to reflect the application to a range of contexts. This is in order to highlight the multidisciplinary application of health psychology constructs. The material in this book will therefore also be relevant to allied health professionals such as physiotherapists, speech and language therapists and occupational therapists who need to support patients to change their behaviour.
The book provides an introduction to the central concepts and techniques of health psychology as they relate to nursing and healthcare. Its applied approach is [Page xii]designed to ensure that both those who have not studied psychology at all and those who have some knowledge, including a psychology degree, will be able use health psychology to enhance their practice.How to Use this Book
This book introduces you to health psychology theories and techniques and sets them in the context of nursing practice and healthcare in general. Each chapter builds on the last in order to provide you with a full understanding of health psychology theories and models. If, however, you have a particular interest in a chapter topic, that chapter may be read independently as you will be directed to related content in others which will enhance your understanding.
Within each chapter you will find points where you are asked to reflect on what you have just read. There are no right or wrong answers – rather these reflection activities are designed to help you to apply the book content to your own work. You are left to make up your own mind up as to where and how health psychology will be useful to you. Throughout the book, simple case examples from different fields of nursing practice are provided. These are there to illustrate the application of health psychology to nursing and healthcare practice. You are also encouraged to consider how the examples reflect or differ from your own experience and that of your patients.
Each chapter starts with a set of learning objectives detailing the knowledge you will gain from reading it. Chapters end with a simple summary of the main points for revision and a reflection activity to help you to apply your new knowledge to your practice. Short quizzes will test your knowledge.
severe and sudden.
an X-ray test that uses dye to examine blood vessels.
Attention deficit hyperactivity disorder
a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness, often abbreviated to ADHD.
a belief with a value component.
the perception of an individual that they are responsible for and have chosen their actions.
behaviour carried out with the intention of avoiding a stressful situation.
verbal or written agreements between a healthcare professional and a patient intended to provide a record of agreed goals and actions.
an activity designed to test whether someone’s beliefs or behaviours are helpful or unhelpful.
the perception that positive changes have occurred as a result of a traumatic or life-changing event.
Body mass index (BMI)
the relationship between an individual’s weight and height, used as an index to determine whether they are at a healthy weight, i.e. a BMI of 20 to 25. It is calculated by dividing weight in kilograms by height in metres squared.
short interventions that may involve discussion, negotiation or encouragement, provision of supportive materials and referral for further support.
an extreme form of work stress, often associated with care-giving professions, that is characterised by emotional exhaustion, a sense of inefficacy and cynicism.
persisting for a long time.
Chronic fatigue syndrome
an enduring condition characterised by extreme or unusual tiredness.[Page 146]
biological processes that follow an approximately 24-hour cycle, responding to light and other environmental triggers.
a thought process including beliefs and perceptions.
showing empathy and concern for another’s, or one’s own (self-compassion) welfare.
a condition, often associated with care-giving professions, that is characterised by a gradual depletion of compassion over time due to prolonged exposure to traumatic situations.
a scale from 1 (not at all) to 10 (extremely confident) used to indicate a patient’s confidence in achieving a goal.
Disability-adjusted life years (DALYs)
a universal metric used to express the number of years lost due to ill-health, disability or early death across a given population.
an interactive research method in which experts provide responses, for instance through a series of questionnaires, with the aim of evaluating accepted practices or assumptions and reaching a consensus of opinion.
a chronic condition in which womb tissue is found outside the womb within the pelvis.
subjection to something, normally through experience.
a medically unexplained syndrome characterised by widespread muscular or musculoskeletal pain.
a positive psychology concept that defines the state of optimal wellbeing.
Foetal alcohol syndrome
irreversible damage to a child’s brain and growth due to exposure to alcohol during gestation.
a diabetic condition which develops in pregnancy (gestation); it is a risk factor for developing type 2 diabetes.
Socratic questioning in the context of cognitive behavioural therapy (CBT), whereby a therapist asks a client a series of questions designed to help them understand their current perception of a situation and to identify different ways of viewing it.
the degree to which an individual has the ability to obtain, process and understand information in order to make appropriate health decisions.[Page 147]
Health promoting financial incentive intervention (HPFI)
an intervention that involves a financial payment to encourage healthy behaviours.
the study of psychological, social, biological and behavioural influences in health, illness and healthcare.
an individual’s beliefs about an illness or its management.
an internal strategy for instigating goal-directed behaviour in the presence of a contextual cue, often formed as an ‘if, then rule’.
the degree to which the planned components of an intervention have been delivered as intended.
experience of success in a task which increases confidence in achievement or self-efficacy.
a variable which explains the relationship, for instance how or why it occurs, between two other variables.
Medically unexplained syndromes
conditions that do not appear to have an identifiable organic cause or whose physiologicial mechanisms are poorly understood; for instance, irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia.
a mental state defined by living consciously in the present.
a description of a process or system.
a variable which influences the strength or direction of a relationship between two other variables and so can tell you whether a relationship can or cannot be expected.
a reason for acting or behaving in a particular way.
the concurrence of two or more chronic medical conditions in one person.
damage to the heart muscle caused by restricted blood flow, commonly known as a heart attack.
pain persisting beyond the time of expected healing which is not associated with progressively severe (malignant) disease.
a type of intervention that uses knowledge of human behaviour to guide someone in a desired direction.[Page 148]
a generalised tendency to expect or hope for a positive outcome.
assistance provided to patients or carers by people with a similar condition to the patient or with experience of caring for someone with a similar condition.
a branch of psychology that studies and aims to promote the positive aspects of human life such as happiness and wellbeing.
positive change that occurs while dealing with stress and trauma. Also known as stress-related growth.
mental or behavioural disorder.
Resistance (in context of motivational interviewing)
a refusal to accept or comply with a change that is deemed beneficial.
a medical procedure in which obstructed blood vessels are unblocked or surgically replaced to restore blood circulation to an organ or other part of the body.
behaviour intended to protect against a fearful situation.
an individual’s capacity to override dominant or habitual responses through self-regulatory behaviours.
an individual’s confidence in their ability to tolerate or successfully overcome a particular situation.
the act of deliberate harm or infliction of injury to one’s body commonly through cutting or burning.
Sense of coherence
a worldview in which life appears comprehensible, manageable and meaningful.
an approach to treatment whereby a patient and their healthcare professional make healthcare choices together, taking into account what is important to each person.
practices intended to foster better quality sleep on a regular basis.
the total amount of social resources available to an individual.
Social desirability bias
the tendency to respond in a way that will be accepted by others.
a network of people available to provide help and support.[Page 149]
the expected behaviour in a particular situation.
help available from others within a social network.
a method of asking questions intended to stimulate discussion in order to improve understanding and to generate new ideas.
relating to the body.
an individual’s perceived importance of a social norm.
an unhelpful belief or distorted way of thinking that contributes to troublesome emotion.
a global, abstract guiding principle.
Very brief interventions
interventions that may take only a few seconds.
a state of contented existence characterised by health and happiness and encompassing a range of psychological and social factors.
Quiz Answers[Page 150]
If you have trouble understanding, if words seem unfamiliar to you or if you need further explanation, check the glossary and reread the relevant sections in the book.Chapter 1
- The randomised controlled trial (RCT) is the best study design for determining the effectiveness of an intervention because of its ability to control for bias and for both known and unknown variables which may have an effect on outcomes above and beyond the intervention being tested.
- A lack of evidence means that insufficient, good-quality trials have been conducted to determine whether or not an intervention works. A finding of evidence of no effect means that good-quality trials have found that an intervention did not work.
- The HBM (Rosenstock, 1966; Becker, 1974) is a ‘cognitive model’ because it emphasises the role of beliefs in health behaviour.
- ‘Perceived behavioural control’ is informed by ‘internal control factors’, such as perceived or known skills, abilities, feeling informed, and by ‘external control factors’, such as perceived or known obstacles, and opportunities.
- Symptoms of depression should have been present for at least two weeks in sufficient severity for most of every day for a diagnosis to be made.
- There is some evidence that female gender, lower socioeconomic status, past history of CMD, alcohol misuse, antenatal and postnatal periods and medical illness are predictors of CMDs.
- The relationship between CMDs and physical illness appears to be bidirectional (may go either or both ways). Biological mechanisms have been proposed, but behavioural factors are also predictors.
- Thoughts, feelings, behaviour and physiology.
- Self-management is most effective when the patient is supported by clinicians and others, has high self-efficacy, has appropriate illness perceptions, adheres to their treatment regimen and when there is shared decision-making.[Page 151]
- Illness perceptions impact on coping actions, emotional outcomes and self-management behaviour.
- According to the ‘Perceptions and Practicalities Model’ (Horne, 2006), non-adherence can be considered as ‘unintentional’ or ‘intentional’, though, in a single patient, non-adherence may have both components.
- According to the ‘Necessity–Concerns Framework’ (NCF) (Horne and Weinman, 1999), illness perceptions associated with treatment adherence can be classified as relating to either perceptions of the need for treatment or perceptions relating to concerns about potential adverse consequences.
- The NICE guidance on individual level behaviour change (NICE, 2014a) suggests that two groups of techniques – feedback and monitoring and goals and planning – are likely to be effective within interventions to change behaviours relating to alcohol, diet, physical activity and smoking.
- SMART – specific, measurable, achievable, relevant, time-bound (though other texts may use slightly different words, the principles are the same).
- OARS – open-ended questions, affirmation, reflective-listening, summarising. These are the four key skills needed to deliver motivational interviewing.
- Interventions which nurses, midwives and health visitors can use to help with action planning and coping planning include: identifying barriers and facilitators, implementation intentions and behavioural contracts.
[Page 152]Chapter 6
- The Fear-avoidance Model (Vlaeyen and Linton, 2000) has been used most comprehensively to explain health behaviours associated with enduring pain and fatigue.
- Catastrophising. The cognitive behavioural model of panic (Clark, 1986) predicts a vicious cycle of catastrophic misinterpretation of the cause and/or consequences of symptoms leading to increasing fear and sympathetic arousal.
- Sleep can be disrupted by: 1) sleep-interpreting processes – misperceptions, dysfunctional beliefs, expectations and attributions concerning sleep and the causes and consequences of poor sleep – and 2) sleep-interfering processes – cognitive, emotional and physiological arousal-producing processes that interfere with sleep such as anxiety, worry, pain or other symptoms.
- People experiencing chronic fatigue commonly ‘push themselves’ or ‘overdo things’ during the times in which they are feeling better because they worry their fatigue will later prevent them from doing what they need or want to do. This tends to result in worse fatigue, followed by the need to rest more. Their sense of frustration is then increased further which leads to them ‘overdoing things’ again when they feel well.
- A factor analysis of studies using a range of measures of nursing-related stress (French et al., 2000) identified the following stressors: dealing with death and dying, conflict with physicians, inadequate preparation to deal with others’ emotional needs, problems with peers, problems with supervisors, workload, uncertainty concerning treatment, dealing with patients and their families and feeling discriminated against (on the basis of age, gender and ethnicity).
- In the study of wellbeing, life satisfaction refers to how people define the overall quality of their lives, hedonic wellbeing refers to experienced feelings or mood, eudemonic wellbeing refers to the person’s judgement of the meaning and purpose of their life.
- The sense that life is understandable and can be managed and is meaningful is known as a ‘sense of coherence’.
- The five ways to wellbeing are: connect, be active, take notice, keep learning, give (Aked et al., 2008).
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